Clinical Case 2

A 47-year-old Afro-Caribbean male is brought in by ambulance as a red standby with reduced GCS and hypoxia. His wife tells you he was well earlier and this morning had a tooth removed at the dentist. When he came home he started complaining of a headache and became groggy. He has problems with his heart and takes heart medicines that he’s been on for a few years.

The ambulance gave 15L of oxygen via a NRB mask as sats were 85%. They have not improved. He is lethargic but is maintaining his own airway and his GCS is 14/15 (E3 V5 M6). He is tachycardic, apyrexial and normotensive. ECG is unremarkable. You suspect methaemoglobinaemia and the diagnosis is quickly confirmed on ABG – his MetHb is 28%. You also note his Hb is 9.9.